Uretero-Sciatic Hernia (Lindbom Hernia): A Case Report and Long-Term Follow-Up.

Ureteric herniation through the posterior pelvic wall is one of the rarest variants of hernias and causes of ureteric obstruction. The clinical features span from asymptomatic to a presentation with severe flank pain and life-threatening infection secondary to ureteric obstruction. The diagnosis needs a high index of suspicion and timely, appropriate radiological investigation. This article presents a case report of a patient who presented with a history of nonspecific abdominal pain and was diagnosed with a left-sided uretero-sciatic hernia (Lindblom hernia). This was managed with routine ureteral stent changes. Long-term follow-up and results from over 10 years of management are presented.

Does magnesium sulfate have a role in the management of severe traumatic brain injury in civilian and military populations? A systematic review and meta-analysis.

INTRODUCTION: Traumatic brain injury (TBI) is a significant cause of combat morbidity. Currently, the medical management of TBI is limited to supportive critical care. Magnesium sulfate has been studied as a potentially beneficial therapeutic agent. METHODS: A systematic review and meta-analysis was undertaken, examining the role of magnesium in the management of severe TBI in adults. The primary outcome of the study was all-cause mortality, with secondary outcomes of Glasgow Outcome Score (GOS) and GCS. EMBASE, MEDLINE, CINAHL, WHO Trial Registry and the Cochrane Library database were systematically searched, with data included until 1 February 2017. Inclusion criteria were: human study; aged >13 years; randomised controlled trial; severe TBI. Exclusion criteria were: data collected prior to 1 January 2002; magnesium commenced >24 hours postinjury; magnesium therapy for <24 hours. Statistical analysis was conducted using Stata (V.13.1). RESULTS: The pooled results of six studies found all-cause mortality not to be significantly different in the treatment group (RR 0.84, 95% CI 0.54 to 1.33; P=0.46) with an I2 value of >70%. With regard to the secondary outcomes, no significant difference in GOS scores between treatment and control was demonstrated. GCS showed a significant improvement in the treatment group. CONCLUSIONS: The meta-analysis found a lack of evidence for magnesium pharmacotherapy in severe TBI, although the data were noted to be conflicting and significantly heterogeneous. Further study is recommended to ascertain whether a therapeutic window exists for magnesium in severe TBI.